MEDICARE: THE LIGHT TIME GIFT HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253J00000X	Foster Care Agency

General Provider Information

NPI Number	:	1205370137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LIGHT TIME GIFT HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	301 EDGEWATER PL
Second Line	:	STE 100
City	:	WAKEFIELD
State	:	MA
Zip	:	01880-1293
Country	:	US
Telephone Number	:	978-876-1065
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 EDGEWATER PL
Second Line	:	STE 100
City	:	WAKEFIELD
State	:	MA
Zip	:	01880-1293
Country	:	US
Telephone Number	:	978-876-1065
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	UNUAGBON TOBI
Credential	:
Telephone Number	:	978-876-1065

Provider Enumeration Date	:	12/12/2016
Last Update Date	:	12/12/2016

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